Angioscopic thromboembolectomy: preliminary observations with a recent technique

Video angioscopy was employed in 12 patients to monitor thrombectomy or embolectomy within prosthetic bypass grafts (n = 4), saphenous vein grafts (n = 2), and native femoropopliteal arteries (n = 6). A flexible, 2.8 mm diameter angioscope was introduced into the vessel for confirmation and accurate localization of the diagnosed embolus. A Fogarty embolectomy balloon catheter was passed alongside the angioscope and balloon inflation was visually calibrated to the exact vessel lumen. Thromboembolic debris was then retrieved under direct visualization. Intraoperative angiograms were obtained in all cases and results were compared with the finding at angioscopy. After conventional thrombectomy, angioscopic inspection revealed residual thrombus within the lumen or adherent to the wall in 10 of 12 cases. Residual debris was also identified in tributary vessels in two cases, and the embolectomy catheter was successfully guided into these channels by the tip of the scope. Limb salvage was achieved in all but one patient, with early follow-up of up to 18 months. As a result of this experience we conclude that angioscopic thromboembolectomy has several advantages over the traditional blind technique: (1) accurate detection and localization of thrombus or embolus; (2) monitoring and control of the degree of balloon inflation, thereby preventing vessel wall damage caused by overinflation; (3) detection and retrieval of residual clot after blind embolectomy; (4) manipulation of the balloon catheter to selected vessels; (5) decreased requirement for repeated arteriograms; (6) increased speed, convenience, and accuracy when compared with intraoperative angiography; and (7) avoidance of surgical exposure of the distal popliteal and tibial vessels.